RT Journal Article
SR Electronic
T1 Cerebroprotection in the endovascular era: an update
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 267
OP 271
DO 10.1136/jnnp-2022-330379
VO 94
IS 4
A1 Anna M Schneider
A1 Robert W Regenhardt
A1 Adam A Dmytriw
A1 Aman B Patel
A1 Joshua Adam Hirsch
A1 Alastair M Buchan
YR 2023
UL http://jnnp.bmj.com/content/94/4/267.abstract
AB Despite advances in clinical diagnosis and increasing numbers of patients eligible for revascularisation, ischaemic stroke remains a significant public health concern accounting for 3.3 million deaths annually. In addition to recanalisation therapy, patient outcomes could be improved through cerebroprotection, but all translational attempts have remained unsuccessful. In this narrative review, we discuss potential reasons for those failures. We then outline the diverse, multicellular effects of ischaemic stroke and the complex temporal sequences of the pathophysiological cascade during and following ischaemia, reperfusion, and recovery. This evidence is linked with findings from prior cerebroprotective trials and interpreted for the modern endovascular era. Future cerebroprotective agents that are multimodal and multicellular, promoting cellular and metabolic health to different targets at time points that are most responsive to treatment, might prove more successful.